Who Makes The Social Security Disability Decision, A Judge Or A Caseworker?

The Social Security Administration does not actually use caseworkers. Caseworkers are typically employed at various departments of mental health and departments of Social Services. Social Security uses claims representatives (CRs) to take the actual disability application or appeal in a local social security field office. Once the claims representative has gathered all of the needed information (at, and after, the disability application interview), they send the disability claim to a state agency (Disability Determination Services, or DDS) for a medical decision.

Once at the state agency, disability examiners, physicians, and vocational staff are involved in making Social Security disability decisions. If an individual’s disability claim is denied, they will have to begin an appeal process that might end with an administrative law judge making their Social Security disability decision.

Prior to going to a disability hearing, an individual must first file a reconsideration appeal that is sent to the same state disability agency that made their initial disability claim decision. The "request for reconsideration" is the first appeal that is available to claimants who have been denied on their application for disability.

It should be no surprise that, at level of a reconsideration appeal, very few initial disability claim denials are reversed to an allowance, especially since the disability decision is being made at the same state disability agency using the same strict decisional guidelines. The only real difference is that a different disability examiner will make the reconsideration disability decision. Unless the first disability examiner made a clear error in the medical determination, or there is new material evidence that allows the reconsideration appeal to be approved, the outcome can almost be guaranteed to be the same.

For most, the only encouraging thing about a reconsideration appeal is that the denial allows an individual to appeal their disability case to an administrative law judge. Although judges have to use the same disability guidelines to make their decisions, they have more flexibility in their interpretation of the medical evidence and the application of the Social Security disability vocational guidelines. Perhaps this is why more disability claims are approved when a judge makes the disability decision.

The national approval rate for disability ALJs is about sixty six percent, which makes it the most favorable level of the disability process.
In a nutshell, Social Security medical decisions are made both by disability examiners and administrative law judges. There are no “caseworkers” in Social Security.